George Winter discusses if healthcare workers should honour their duty of care to their patients during the pandemic, when doing so puts themselves and their families at risk
IntroductionFactitious hematemesis is the bleeding type of Munchausen’s syndrome together with dual diagnosis of school refusal is rarely reported in the literature. It is a condition in which the ...patient intentionally produces symptoms to assume a sick role and gain medical attention. Underdiagnosis of this disorder results in the unnecessary use of medical resources, i.e. unnecessary medical tests and evaluations.ObjectivescaseWe present this rare case of a patient with chronic factitious disorder who presented to the emergency with hematemesis. The 12 year old male patient grade 6 student presented with curious history of hematemesis just before the entrance of school and in the new school premises since 2 years resulting in school refusal and multiple doctor shopping. The patient underwent laboratory tests (such as the examination of sputum specimens, urinalysis, complete blood evaluations) and diagnostic studies (fiberoptic bronchoscopy with bronchoalveolar lavage, computerized tomography and radiography of the chest, bronchial arteriography, endocopic studies etc), because he continually presented with hematemesis, in order to spot and discover the nature of the bleeding. Since such examinations failed (a few of them-namely fiberoptic bronchoscopies--were even performed when he was coughing up blood) and psychiatric consultations revealed the presence of psychologically traumatic events in the patient’s history which could explain the psychopathic traits of her personality (in fact she was aggressive and unstable in interpersonal relations), a diagnosis of factitious hematemesis in Munchausen’s syndrome was made.MethodsThe typical characteristics that should prompt the physician to include Munchausen syndrome in the diagnosis include deliberately lying, repeatedly coming to the clinic/hospital with similar complaints in a short span of time, taking excessive drugs (especially insulin and warfarin) to induce side-effects, recurrent abdominal pain, scars on limbs, and rheumatologic and hematological disorders.ResultsWe recommend that physicians all across the globe should report more cases of Munchausen syndrome. More research is required in this arena to understand the cultural, social, and psychological aspects of Munchausen syndrome and to find out which treatment strategy can be most beneficial for such patientsConclusionsMunchausen syndrome is a diagnostic dilemma that needs to be given adequate medical and social attention by encouraging further research and spreading awareness not only amongst the general population but also health care providers. With proper evaluation, diagnosis, and psychotherapy, the disease will not remain a diagnostic dilemma and would be easier to control and treat. This case report will contribute towards the awareness of physicians about Munchausen syndrome and the strategies to diagnose and treat it.Disclosure of InterestNone Declared
What is happening as a result of poor staffing levels is completely unacceptable (Urgent patient safety review urged after nurses blow the whistle on staffing shortages, news online).
Nurses have a duty of care to patients. But there may be circumstances where you will able to justify refusing to treat a patient. What are the grounds you would need in such cases, and what might ...the implications be?
Résumé : La question de savoir si les entreprises ont des obligations vis-à-vis de leur chaîne d’approvisionnement fait actuellement l’objet d’un débat croissant. La discussion se base sur des ...initiatives législatives nationales et européennes qui veulent obliger les entreprises à surveiller leur chaîne d’approvisionnement du point de vue des droits de l’homme, de la protection de l’environnement et des normes du travail. Cet article propose d’intégrer l’analyse sociale et économique des chaînes de valeur mondiales dans la question des obligations à la charge des entreprises en matière de chaînes d’approvisionnement. Sur cette base, il discute de la fonction fondamentale que peuvent jouer les obligations qui incombent à l’entreprise individuelle dans le but d’une amélioration écologique et sociale dans la production mondiale de biens et de la systématicité qu’elles présentent. L’article se réfère à titre d’exemple au devoir de vigilance consacré par la loi française de 2017 et à la loi allemande sur le devoir de diligence de 2021.
Purpose
This paper aims to convey the different ways in which HR managers can prepare their staff for the return to business travel.
Design/methodology/approach
The author has based her findings on ...years of firsthand experience in the field of business travel expense management.
Findings
This paper proposes that HR teams should shape travel policy for success and maintain clear communication with teams, which are the surefire ways to prepare teams for the return of business travel.
Originality/value
This paper provides value for HR managers who are dealing with employees who are perhaps anxious about making business trips for the first time since the pandemic.
During the COVID-19 pandemic, the media have repeatedly praised healthcare workers for their ‘heroic’ work. Although this gratitude is undoubtedly appreciated by many, we must be cautious about ...overuse of the term ‘hero’ in such discussions. The challenges currently faced by healthcare workers are substantially greater than those encountered in their normal work, and it is understandable that the language of heroism has been evoked to praise them for their actions. Yet such language can have potentially negative consequences. Here, I examine what heroism is and why it is being applied to the healthcare workers currently, before outlining some of the problems associated with the heroism narrative currently being employed by the media. Healthcare workers have a clear and limited duty to treat during the COVID-19 pandemic, which can be grounded in a broad social contract and is strongly associated with certain reciprocal duties that society has towards healthcare workers. I argue that the heroism narrative can be damaging, as it stifles meaningful discussion about what the limits of this duty to treat are. It fails to acknowledge the importance of reciprocity, and through its implication that all healthcare workers have to be heroic, it can have negative psychological effects on workers themselves. I conclude that rather than invoking the language of heroism to praise healthcare workers, we should examine, as a society, what duties healthcare workers have to work in this pandemic, and how we can support them in fulfilling these.
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